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Is it okay to talk about suicide?

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*Warning – the following discusses mental illness and suicide. This may be a trigger for vulnerable community members. 

 

There remain a number of taboos around suicide, rendering seeking help potentially more difficult to seek than it needs to be. Moral, religious and even Aristotle’s economic contribution ideology have historically fed into the taboo that has arisen around both suicide, talking about suicide and living with suicidal ideation.
The rate of suicide in the US is more than twice that of people that die by homicide each year, but we seem to only hear about homicides. In Australia suicide is the leading cause of death for 15 to 44 year-olds. One of the greatest concerns around talking about suicide is that if we bring it up in conversation, we’ll put those thoughts in the person’s head. There is simply not enough evidence to suggest one way or another that direct questioning is helpful or harmful. Here are some thoughts.

Gender and suicide:

In Australia, 80% of completed suicides are men. In 2016 a Black Dog study found the increased risk where the following are present:
– A period of disrupted or depressed mood
– Unhelpful conceptions of masculinity – the ‘tough Aussie bloke’ stereotype in particular
– Social isolation
– At least one personal stressor, like unemployment or relationship breakdown.

Poor mental health remains the most common factor in complete and incomplete suicides, with men in the Black Dog study reporting that unaddressed mental health problems led to an increased inability to manage stressors, leading to unusual decision making and a sense of a lack of resilience (see discussion on resilience here).

In Australia, men complete suicide three times more often than women. Having said that, women are more likely to experience incomplete suicide (formally suicide *attempts*), and over the past year we have seen a 26% increase in completed suicide by women. The highest rate of suicide reported in 2015 was men in 85+ age group with 68 deaths, controversial, though if we could begin to talk about euthanasia (another great taboo), what would this particular rate look like for people over 80 with chronic and terminal illness? I digress.

We also know Aboriginal and Torres Strait Islander people are twice as likely to die by suicide than non-Indigenous people. The only State or Territory to see a decline in suicide rates (2015-16) was South Australia, while all other areas of Australia reported stable or increasing figures.

Since this blog is primarily centred around Bipolar Disorder, let’s talk about that. Bipolar, mental illness and suicide. I’ve got issues, and my diagnosis of Bipolar is the least of them! 

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I’ve been known to hold controversial opinions via my lived experience of Bipolar Disorder, and while I do not claim to speak for all people with Bipolar, my 20+ years in the area of mental health has confirmed to me some of my views to be held of reasonable truth.

– The distinction between Bipolar I and II and suicidal ideation has most recently been found to be more similar to one another than distinct, as has been historically reported.

– Suicide doesn’t kill us, Bipolar Disorder does.

– A person with Bipolar Disorder can experience suicidal ideation even when well. The thought of cycling through mania and depression when well has been reported to be a factor in ideation while well.

– People living with bipolar have a suicide risk 17 times that of the general population.

– The majority of people with mental illness do not attempt suicide, though, with a condition like bipolar, the connection is undeniably strong: around 1 in 4 people living with bipolar attempt suicide and bipolar accounts for 12% of all suicides each year, while accounting for 2.5% of the population.

– We need to STOP using the term ‘resilience’ and start talking about resourcefulness! (subsequent post to come)

Language and why it matters: Society, community and the personal self. 

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The Personal Self:
Ever heard someone say “they went psycho”, “he *must* be manic”, “she’s hysterical/manic/insane etc”? These terms have become fair game in the realms of bantering and in *the spirit of fun*, listening to these sorts of throwaway comments is far from fun or jovial, they are thoughtless insults which act to characterise a persons frailty or perceived fault…and it isn’t funny.
Replace any of these terms with words that relate to a persons culture, other disability, HIV status, cancer, chronic illness etc, and well, you get the point. These terms associated with a persons mental health status are often thrown around; at one end subtly implying a person has “psychological disturbances”, through to the other end of the spectrum, as targeted insults towards a person with a mental health problem. Designed to separate the speaker from the *other* person, to state separation, to elevate the speaker, and even where the target isn’t in the room, anyone with a mental health problem (or anyone with half a brain) could see how these words would hurt.

More seriously, these sorts of insults are a form of STIGMA. While stigma is a term which has evaded clear, operational definition, it can be considered to contain three inter-related problems:
– a lack of knowledge (ignorance),

– negative attitudes (prejudice),

– and excluding or avoiding behaviours (discrimination)

For young people, still finding their voice, still working out how to best manage their mental health problem, this type of language acts as a barrier to seeking help. If your child, niece, nephew, etc heard this kind of ignorant speech from you, guaranteed it will lessen the likelihood of them seeking help via you…and that’s a real fucking problem.

As few as 4% of young people with a mental illness seek help from a family doctor or health professional. Primarily they are going to seek help from friends and family, from those they trust, and where we are not aware of the way in which our language hurts and stigmatises mental health problems (and subsequently the young person), the language we use is a contributory factor towards the reluctance of many young people to seek help for mental illness. The good news is that this is reversible. Start to consider the language you use, the way in which you speak to young people around you about mental illness and mental health, since through direct positive contact, it can be extrapolated that for every positive conversation we have with our young people about mental health, it will take 6-8 negative contacts to undo the positive effect our interaction has had.

We’re always telling our young people to watch their language, now we need to watch ours. Doing so is one easy step we can take to encourage young people around us to seek the help they need in relation to their mental health.

The Community Approach:
The jury is out in relation to whether or not we should have direct conversations about suicide with someone who is potentially vulnerable. In Australia we have seen a push towards having these direct conversations, asking the question “are you thinking about suicide?”, though the fact remains, there is simply not enough evidence to say this approach is effective and doesn’t cause further harm.
For people with reduced resourcefulness (a lack of services in their area, a lack of family or friend support, unawareness of what supports are available), potentially asking this direct question can cause further harm since they are left unsupported and with their own thoughts, we simply haven’t done the research to know the results.
Hence at a societal and personal level, reducing stigma is known to increase the likelihood of someone seeking help themselves. There remains a difference between someone coming to you to share their thoughts of suicide, and that of noticing a change in behaviour or having our own worries about someone and asking THE question. With not knowing the impact of asking “are you thinking about suicide?”, surely then addressing any mechanism possible to increase the likelihood of self-help seeking behaviour is key.
Considering the lack of evidence in the area of asking about a person’s suicidal ideation, I would no longer do this, and recommend a more subtle (and potentially more suitable) approach like ensuring the person is aware of professional services in the area; “I’m worried about you. I’m here to listen and I have some help service numbers if you want them?” versus “I’m worried about you. Are you thinking about suicide?”…controversial, I know! and flies in the face of the general approach here in Australia.

Society, community and personal approaches to address suicide:

– Address stigma where and when we see/hear it. Be aware of the language we use, since we know that stigmatising language (even between a parent and child or peer to peer) reduces the likelihood of that person seeking professional help.

– Have a specific mental health curriculum embedded in schools.

– Make crisis support information more readily available. In schools/workplaces/public spaces, have flyers or posters with support service details displayed.

– Target people at higher risk, those with Bipolar Disorder, Schizophrenia, clinical depression.

– Address Indigenous rates of suicide through genuine actions towards enhancing cultural connectedness and individual and kinship autonomy.

– Train up community facilitators to identify those at risk and by building public awareness about mental illness and suicide.

– Provide young people with meaningful engagement and have at hand information in relation to mental health/illness and suicide support.

– Put in place a community-oriented national suicide prevention strategy and action plan which goes beyond clinical support.

– Challenge current approaches to suicide prevention, fund research into approaches and acknowledge findings, even if they are counter to our current approaches.

– Recognise that simply opening up discussion without supports in place may be more of a harm than a benefit.

 

Just having a conversation is insufficient. If you go to a high school and you have a suicide expert stand up in front of 1500 students and talk about suicidal warning signs and then leaves and that’s all you do, there is evidence to suggest that that is dangerous.” – Ian Manion, PhD, C. Psych.University of Ottawa.

 

 

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“Lord Of The Rings” Star Sean Astin Talks About Bipolar Disorder And Calls For Earlier Symptom Recognition

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“Lord Of The Rings” Star Sean Astin Talks About Bipolar Disorder And Calls For Earlier Symptom Recognition

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Actor Sean Astin, best known for his role as Sam Gamgee in the Oscar-winning “Lord of the Rings” film trilogy, is willing to share his personal experience living with a family member diagnosed with bipolar disorder in order to help increase awareness of the symptoms associated with the condition.

Astin witnessed the condition’s trademark highs and lows throughout his childhood when his mother, actress Patty Duke, experienced symptoms of undiagnosed bipolar disorder for years before receiving an accurate diagnosis and effective treatment. Duke’s delayed diagnosis is not uncommon and mirrors the results of a new survey of more than 500 people with bipolar disorder, which shows an average delay of 13 years between symptom onset and diagnosis.

The survey, which was conducted online by Harris Interactive and sponsored by AstraZeneca, included 500 persons medically diagnosed with bipolar disorder.

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“Though my mom was the one who struggled with the symptoms, the…

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Bipolar disorder is not a character flaw: Finally! (A psychiatrist speaks out)

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So today marks World Bipolar Day and generally speaking, people with Bipolar Disorder continue to experience stigma, discrimination and misunderstanding. Today Professor Phil Mitchell, Head of Psychiatry at the University of New South Wales, spoke in defence of sufferers such as myself, noting that Bipolar should be treated no differently than other illnesses such as diabetes or cancer.  He goes on to note that people with lived experience of Bipolar don’t intend to make life difficult for either themselves or others and that as a mood disorder much of the associated symptoms are like other diseases.

I feel that this article is well timed and for a change, I feel as though I have a psychiatrist batting in my corner, it hasn’t always been like that. When I first visited a psychiatrist (at the recommendation of my psychologist), I was as yet undiagnosed and obviously un-medicated. I spoke to this psychiatrist the same way in which I spoke to most people, you see at the time I identified as a medium and psychic. As we sat down I spoke to him of his dead Aunt, who I believed was standing next to him and giving me messages to relay. Needless to say by the time our session was complete I had a script for anti-psychotics and mood stabilisers. I went back to my psychologist and he recommended I seek another opinion, just to be sure.

I sought out another psychiatrist, this time a female and from a different cultural background. This was important to me, since I felt perhaps her diverse cultural experience may impact on the outcome of my diagnosis, or at least on the medication regime prescribed. I wasn’t disappointed. I still came out with a diagnosis of Bipolar Disorder, although this time it was Type II, not Type I. She also felt we should begin with mood stabilisers only. Her words had a huge impact on me, since both in and out of hospital, my experience with Psychiatrists left a lot to be desired. She mentioned that I was reporting spiritual phenomena and that (in her opinion) there were things that psychiatry couldn’t explain. She challenged the status quo by asking who she was to contest my perceptions that I was indeed a physic and a medium. She shared with me some of the cultural singularities that still takes place in her home country, all of which involved shamanic practices and fortune telling. That was a number of years ago and I have remained relatively well on the mood stabilisers and have had no need for anti-psychotics (although I still hear voices and see things that may not be there).

I manage to raise my children well, hold down a part time job and continue studying at university. I recognise that people see me as eccentric or some such thing and I have had it reported to me that I’m (apparently) quite unusual in my approach to life and to my role as a manager.

The article goes on to talk about the way in which people with Bipolar Disorder need support around them, similar to the other illnesses mentioned, helpful partners, doctors and friends/colleagues all go to make our journey more bearable. This takes me to a time when I was supporting my mother through cancer. She had days where she was so unwell (physically and mentally), so exhausted and so run-down that she couldn’t get out of bed, while other days she was able to go about functioning relatively normally. I resigned from a job to take care of her almost full-time. I would take her to appointments, make her meals, sit with her and keep her company. She came through in the end and is in full remission.

When I ‘came out’ to my parents about my diagnosis of Bipolar the look of horror and confusion said it all. My father explicitly asked whether I was like ‘them’ (meaning the service users I had worked with in my mental health role). Although I left literature around for my parents, my illness remains a taboo topic and one, which they avoid at all costs. I could take up the baton and really ‘get to the bottom of it’ with them, although I feel this is more effort than it is worth. I have enough friends and supports around me to not need to go into battle with them in relation to their own stigma. This is how I feel about my illness, battling ignorance, misinformation and stigma are constants in my life and in order to not become completely worn down, I need to choose my battles carefully.

Currently I work proudly with a mental health organisation that educates the police/services, community, schools and clinicians to raise awareness and reduce stigma around mental illness. I’ve had a great number of conversations with federal and state police and mental health clinicians who are engaged and enthused to address the matter of mental health stigma. Coming across this article today was a reminder that not all are against ‘us’ and that reducing stigma by people both with and without lived experience is the best way to go. When a Psychiatrist can speak so boldly about such matters, I know that, while we have some way to go, things are changing for the better.

http://www.sbs.com.au/news/article/2014/03/30/bipolar-disorder-not-character-flaw-psychiatrist

Australian Services

Lifeline
For all ages
24hr helpline: 13 11 14
Chat online

Suicide Call Back Service
For all ages
24hr helpline: 1300 659 467
Chat online

Beyond Blue
Ph: 1300 22 4636

Sane Australia
Ph: 1800 18 SANE (7263)

Black Dog Institute
Clinics: (02) 9382 2991

 

Bipolar Disorder & Unemployment

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In relation to my lived experience of Bipolar Disorder, there have been some highlights of my career and some areas that I work to improve and I have come to recognise that both are interchangeable. A recognised trait of my workplace practice is that of ‘innovation’. I’ve worked managing programs for more than a decade, in fact it has almost been two-decades if I were to be honest. I bring to program management…

…and development an ‘outside of the square’ approach to development of content and the implementation of mentioned programs.

In this respect, I have found myself in circumstances whereby I rapidly progress through an organisation, since employers often see my innovation and creative approach to management as an enduring trait or feature, when in reality, I have come to see that it is one of many facets of my illness, bipolar disorder.

It isn’t unusual to read about the linkages between bipolar and ‘creativity’ (how ever this may manifest). For someone such as myself, this can work as an advantage, since it can set me apart from colleagues who have an alternative method of cognition. While I recognise that my illness is relatively well contained, (I can hold a job, even if temporarily and I have studied at post-graduate level, even if my study is punctuated with hospitalisation), and that others have difficulty managing day-to-day living, it all becomes relative and in my case what initially arises as an organisational benefit can (as does) become a liability given time.

I have come to reflect that there are particular symptoms associated with bipolar disorder which affect me in the workplace and not in my private sphere. Where as a private citizen I can ride the peaks of my euphoria through art, music and writing, this must be done within my own time and according to my own agenda. The organisational context simply doesn’t permit this. By this I mean that (even on medication) my euphoric states can see me create well into the night, with the obvious repercussion of exhaustion the day following and the day after that. This simply doesn’t work in an organisational context, where the hours I work are dictated by powers (and logic) beyond me.

As do many with bipolar disorder, I have bursts of engagement and clarity with the pay-off of down periods and depression (usually as a recuperative measure which is out of my control). This moments of elation see me producing some of my greatest works. When these episodes of mania go unaddressed or begin to spiral out of control, I lose the creativity, the insight and direction that I so desire.

Up until my latest role, I have never identified as having a lived experience if bipolar disorder, and so from the surface (resume in hand) I appear highly functional and able to ‘cope’ in the world created around me. Hiding in the closet tends towards me gradually becoming undone. I can tend towards spiralling into paranoia, and when very stressed, I head back towards my delusions and hallucinations. Looking at my current role, I can see the benefit of coming out of the closet, both for myself and the organisation. You see, my current role is an identified position. The organisation actually encouraged people with ‘lived experience’ to apply. This is most unusual, considering it is a senior role. In my new position I can head into work and disclose that “I didn’t sleep well last night, and I’m feeling quite elated”, “I’m feeling exceptionally sad/down and I have no understanding of why”…these statements and the ability to express them, see my team gather around me (or give me space depending on what I need) and my manager allocate work that suits my current state of mind. This is hugely effective and I know I am fortunate to have such a position in such a supportive organisation.

This approach to enabling people to identify as having a lived experience acts to benefit the individual, the team and the organisation, since as we know, there are plenty of people in the workplace who are unable to disclose their mental illness, which undoubtedly (and through experience) only furthers the symptoms and effects of the mental illness itself.

Why can’t we have identified roles in organisations, such as we do for particular culturally diverse people and gender specific roles. Identified roles act to support the individual and to build work-place and personal esteem. It enables an organisation to experience first-hand the value of employing someone with a mental illness and to harness the unique capabilities a person with lived experience can provide. I don’t mean to romanticise mental illness by any means, since the employment of myself comes with some organisational cost…winter is a season when I require extra down time, while spring is a time to embrace my zest for life. I don’t ask for special concession in my identified role, simply because I don’t need to. Concession isn’t given, understanding and empathy are and in-turn I infuse my creative nature into my role and the programs I manage.

While in the closet I managed to have some great success in putting programs on the map. Taking local programs and receiving national recognition. While this was hugely advantageous to the organisation, this practice was not sustainable, since as a person with bipolar disorder, once I hit the mark I am looking for the next adventure, the next program to establish…I simply don’t do repetition well. I have found now, an organisation that actively moves staff between roles and programs in order to keep those who need regular (in my case 2-yearly) stimulation. It works well and it works to everyone’s advantage.

For people such as myself, those able to work while managing mental illness, I would call for more identified roles, which act to provide equity to those with lived experience while also harnessing all that such a diverse population has to offer. The identified role I currently have is not the norm. I wish it were. It is only a matter of time before my next creative influx that I begin to have a closer look at ‘identified roles’ – high level roles which harness intelligence and support all involved, all while offering an educational experience to the broader community. Here’s to the next 2 years.